Knowledge Base Article
Somebody's Watching You!
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Somebody's Watching You!
Friday, October 26, 2012
How many times have you heard someone say that complete and accurate medical record documentation and quality improvement efforts are vitally important because they impact what is being publically reported about your hospital? Well, it’s true. But who exactly is looking at you?
The Centers for Medicare and Medicaid Services (CMS) has provided an educational tool for hospitals titled Contractor Entities At A Glance: Who May Contact You About Specific Centers for Medicare & Medicaid Services (CMS)
- Program Integrity Contractors (i.e. Recovery Auditors, Zone Program Integrity Contractors (ZPICs), Comprehensive Error Rate Testing Review Contractor (CERT RC) and Medicaid Integrity Contractors (MICs)),
- Quality Contractors (i.e. Quality Improvement Organizations (QIOs)),
- Specialized Work Contractors (i.e. Medicare Coordination of Benefits Contractor (COBC)),
- Claims Administrative Contractors (i.e. MACs, DME MACs); and
- Appeals Contractors and Entities (i.e. Qualified Independent Contractors (QIC) and Administrative Law Judge (ALJ).
While this is a great tool for hospitals to understand who may contact them, what sources are available for the public to use to select a physician, a hospital, a nursing home, etc.?
In June of 2011 the Robert Wood Johnson Foundation launched a
National Directory that is a compilation of state, federal, hospital and health plan quality data from across the country. The Foundation indicates that “our directory provides access to publicly available, free reports with information about the process of delivery care (for example, did patients get all the recommended care?), actual outcome for patients (for example, did patients die or have to return to the hospital?), what patients said in surveys about their experience with physicians or hospitals, and/or cost.” In the 16 months since the Directory was launched the list of public reports has increased from 224 separate sites to 258.
Below is a much smaller list of sites compiled by MMP, Inc. to provide you with an idea of who is publicly reporting data about your hospital and information about each report.
We believe that focused efforts on complete and accurate medical record documentation, quality improvements efforts and understanding what is being publicly reported about your efforts are positive steps towards clients embracing the shift in health care away from the traditional Fee-for-Service model towards payment for Quality Care as evidenced by current initiatives such as the 30 Day Readmission Reduction Program, Value-Based Purchasing and Accountable Care Organizations.
This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.
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